Active NPI
Bena Tak Yee Chan Camello
- Clinical Social Worker
- Stockton, CA
National Provider Identifier
1053581116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 65302
- Practice address
- 1212 N California St
Stockton, CA 95202-1552 - Phone
- (209) 468-8686
- NPI assigned
- Mar 5, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 65302 | CA | Primary |
Addresses
Primary practice location
1212 N California St
Stockton, CA 95202-1552
Mailing address
1212 N California St
Stockton, CA 95202-1552
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65302 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556582400000",
"number": "1053581116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 N CALIFORNIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1212 N CALIFORNIA ST",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952021552",
"telephone_number": "209-468-8686"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMELLO",
"first_name": "BENA",
"middle_name": "TAK YEE CHAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-05",
"last_updated": "2019-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "65302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.